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The taxman is now playing doctor

How today’s tax returns will impact tomorrow’s medical bills

By

JonnelleMarte

When they file their returns this year, some Americans will get a medical bill with their tax bill.

Starting next January, the Affordable Care Act mandates that every American have health coverage, and those who remain uninsured will pay a penalty. The extent to which one is eligible for federal subsidies to buy insurance, and the penalties for failing to comply with the mandate, will both be determined using one number: the adjusted income reported to the Internal Revenue Service this year. “So much of the Affordable Care Act is being implemented through the tax code,” says Kathy Pickering, executive director of the Tax Institute at H&R Block. And for many taxpayers, “their tax situation will factor into health-care decisions as well,” she says.

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The penalty, which was upheld as a tax by the Supreme Court in June, will vary per family based on their size and income. The fee starts at $95 per person next year, or 1% of household income above the minimum threshold for filing a tax return—whichever is greater. And the penalty is scheduled to increase each year to $695 per person in 2016, or 2.5% of income. (After that, the penalty will be adjusted each year for inflation.)

For a single person earning $50,000, the charge would start at $400 next year, estimates H&R Block. And for a family of four with two children and a household income of $100,000, foregoing insurance would add another $800 to their tax bill -- a sum that would be deducted from any refunds. (The penalty is cut in half for children.) The government will provide subsidies, which would cap how much families spend on insurance premiums to a portion of their income. These subsidies will be available to those earning incomes of up to 400% the poverty rate, which works out to roughly $45,000 for an individual, and $92,000 for a family of four. See H&R Block Health Care Estimator

To be sure, people who get health insurance through their employers or through a government program like Medicaid will not be impacted by the penalty. But those shopping for insurance on the individual market may still opt to pay the penalty, experts say. Annual health insurance premiums for people working at small firms averaged $5,600 for individuals and $15,200 for families in 2012, according to the Kaiser Family Foundation. (Of course, the decision to remain uninsured could end up being far more expensive if individuals face unexpected medical emergencies.)

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In order to avoid the penalty, taxpayers will need to buy the minimum amount of health insurance required under the health-care law. One way to meet that amount is to purchase a plan offered in the individual insurance exchanges being set up by health-care reform, where individuals or small-business employees can shop for health coverage—possibly with the help of federal subsidies. Levels of coverage will vary, and some plans will have to offer essential benefits including hospital, emergency, pediatric benefits and other services. Dental-only plans, for example, won’t be enough to avoid the penalty.

Tax preparers say clients are already asking questions about how health-care reform will impact their tax bills—and vice versa. At H&R Block, preparers are calculating what a taxpayer’s insurance costs might be by using their returns to estimate the federal subsidy they might receive. They’re also talking to families about what penalty they would have to pay over the years if they decide not to buy insurance. Mark Steber, chief tax officer for Jackson Hewitt Tax Service, says they are fielding questions from taxpayers on the penalty and how insurance subsidies will work, and that the firm is evaluating if it will add a health-care component to its tax prep services.

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